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Intravitreal bevacizumab for exudative age-related macular degeneration after multiple treatments

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Abstract

Background

Photodynamic therapy with verteporfin (PDT) significantly reduces the risk of vision loss in patients with exudative age-related macular degeneration (AMD). Indocyanine green-mediated photothrombosis (IMP) and transpupillary thermotherapy (TTT) may also be beneficial for selective cases of exudative AMD. However, a substantial subset of patients responds poorly to these treatments. Intravitreal bevacizumab (IVB) has been recently used in the treatment of exudative AMD, showing both visual and anatomic improvement in the majority of cases.

Methods

This interventional retrospective case series reports the effects of IVB in 17 eyes with subfoveal neovascular AMD that had undergone repeated PDT (combined or not with triamcinolone acetonide) or PDT followed by either IMP or TTT with poor results. The main outcome measures were visual acuity and tomographic signs of intra/subretinal fluid, as well as central retinal thickness.

Results

Most patients received a single IVB injection. The mean follow-up was 4.47 months. The mean logMAR visual acuity changed from 1.17±0.40 to 1.06±0.44 (P=0.17). The mean central retinal thickness decreased from 404.05±245.26 to 280.23±143.14 μm (P=0.032). At the end of the study, lack of tomographic signs of intra/subretinal fluid was noted in four (23.5%) eyes. No ocular or systemic side effects were identified.

Conclusions

Short-term results with IVB for the treatment of exudative AMD have been promising. However, the chronic retinal and pigment epithelium changes frequently present in eyes that underwent multiple previous treatments may limit complete visual recovery. To our knowledge, this is the first report on the use of IVB for this particular group of AMD patients.

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Acknowledgements

The authors thank Philip J. Rosenfeld, MD for the valuable discussion of some cases herein presented and Marcos Yassuhide Endo for the edition of Figs. 3 and 4.

Financial disclosure The authors have no proprietary or financial interests in the material and methods mentioned in this article.

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Authors and Affiliations

  1. Vision Institute, Federal University of São Paulo, São Paulo, Brazil

    Fabio Bom Aggio, Michel Eid Farah, Wagner Camilo Silva & Gustavo Barreto Melo

  2. Alameda Jaú, 150 ap 21 B., São Paulo, SP 01420-000, Brazil

    Fabio Bom Aggio

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  1. Fabio Bom Aggio
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  2. Michel Eid Farah
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  3. Wagner Camilo Silva
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  4. Gustavo Barreto Melo
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Correspondence to Fabio Bom Aggio.

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Aggio, F.B., Farah, M.E., Silva, W.C. et al. Intravitreal bevacizumab for exudative age-related macular degeneration after multiple treatments. Graefe's Arch Clin Exp Ophthalmol 245, 215–220 (2007). https://doi.org/10.1007/s00417-006-0412-5

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  • DOI: https://doi.org/10.1007/s00417-006-0412-5

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